America drinks and goes home, and dies?

An alleged intoxicated man transported to Rhode Island Hospital by rescue personnel for detox was reportedly released two hours after being seen, only to die early the next morning – the same day that new standards for emergency departments for treatment of substance use disorders were announced

By Richard Asinof

Posted 3/20/17

Why is this story important?

The story of an alleged intoxicated man transported by rescue personnel to the emergency room at Rhode Island Hospital for detox and reportedly released two hours later, who then died early the next morning, without evidence of foul play, raises questions about how alcoholism fits within the new standards for treatment of substance use disorders by emergency departments.

The questions that need to be asked

What were the outcomes for the 6,210 EMS transports in 2016 in which alcohol was either the primary or secondary impression? How many were referred for treatment? How many went? How many met with peer counselors at emergency departments? How many were repeats involving the same individual?
Will alcohol be added to the new standards of treatment for emergency departments in Rhode Island? What is the connection between alcohol abuse and domestic violence? What was the cause of death from the autopsy of the 35-year-old man who died?
Who will convene a public conversation to talk about the economics of despair and its connection to the high death rate among young Rhode Island adults from drugs, alcohol and suicide? Will Lifespan officials convene an internal review around emergency department practices around patients who present with alcohol as a primary or secondary impression by EMTs?

Under the radar screen

A potential factor in the reason behind releases in cases of patients presenting with alcohol intoxication at emergency departments, according to one professional who works in the substance use disorder field, is that detoxing from alcohol often creates a dangerous medical situation, both for the provider and the patient, requiring intensive and costly medical intervention.

BARRINGTON – Like many of the stories reported in the police logs published by weekly community newspapers, one cannot make this stuff up.

The headline for the online story posted on EastBayRI on March 16 read: “Police: Man sent to hospital for detox dies later than night.” The subhead continued: “Police say there was no sign of foul play.”

The story began: “Barrington police responded to a home in Barrington early Tuesday evening, March 7, after an Uber driver called the station to report that he was transporting a highly intoxicated man to a Barrington home.”

The story continued: “Police said the man, a 35-year-old West Warwick resident, had apparently passed out in the car while it was traveling to his girlfriend's home in Barrington; he was also carrying an unopened 12-pack of beer.”

Next, the story said: “Police arrived at the Barrington home and later called for the fire department to transport the man to the hospital for detox.”

The police chief in Barrington confirmed to ConvergenceRI that the man had been transported to Rhode Island Hospital for “detox.”

Story takes a twistHere the story took a twist: “The man went to the hospital a little after 7 p.m. and was reportedly released around 9 [p.m.]. He then went back to the Barrington home and went to bed at 11 p.m.”

The police were called back to the Barrington home early the next morning: “Police were then called to the home again at 4:30 a.m. the next morning after the homeowner reportedly found her boyfriend had died at some point during the overnight hours,” according to the story.

The story concluded: “Police said an autopsy was conducted that revealed no evidence of foul play.”

[The official determination of what “drugs,” if any, may have been involved with the death could take up to three months, under current protocols at the R.I. Department of Health.]

America drinks and goes home – and diesIronically, on March 8, the same day that the 35-year-old man from West Warwick died, Gov. Gina Raimondo’s Overdose Prevention and Intervention Task Force released the first statewide standards in the nation for treating overdose and opioid use in hospitals and emergency settings. [See link to ConvergenceRI story below.]

As reported by ConvergenceRI: The new standards were driven in large part by the passage in 2016 by the R.I. General Assembly of the Alexander C. Perry and Brandon Goldner Law, which mandated comprehensive discharge planning by hospitals and emergency departments. Perry and Goldner both had visited emergency departments because of substance use disorder issues prior to their fatal overdoses.

The law reflected the anguish of prominent parents whose sons had died despite their frequent visits to hospital emergency rooms – Goldner was the son of Barbara and Brian Goldner, the CEO of Hasbro, and Perry was the son of former R.I. Senator Rhoda Perry.

The main goal of new levels of care “is to standardize humane, evidence-based care of patients with opioid use disorder in the state’s emergency and hospital institutions,” according to a 20-page document produced by the R.I. Department of Health and the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

But the new standards do not appear to explicitly cover protocols for alcoholism, except perhaps in a broader interpretation of “discharge planning” for those who have a substance use disorder diagnosis.

Four professionals confirmed for ConvergenceRI that alcoholism could be considered a substance use disorder diagnosis.

One further irony: March 7 was the day that Rep. Moira Walsh, appearing on the WPRO talk radio show hosted by Matt Allen, said that there was “an insane amount of drinking” that went on at the State House, a statement that created strong pushback from some state legislators.

Do the new standards cover alcohol?At the crux of the story is the unanswered question: Why was a person, taken to the emergency room at Rhode Island Hospital by rescue personnel from Barrington for detox, seen around 7 p.m. and then reportedly released two hours later?

[Another question: Upon release and return to the home in Barrington, how many cans of beer from the 12-pack were consumed?]

ConvergenceRI reached out to the R.I. Department of Health to ask whether or not the new standards for emergency settings such as hospitals covered detox admissions for alcoholism.

ConvergenceRI also asked about the number of emergency medical service transports that were involved with alcohol in Rhode Island in 2016.

“In 2016, there were 6,210 EMS transports in which ‘alcohol’ was either the primary or the secondary impression,” Wendelken said, explaining that EMS professionals do not make diagnoses. “They instead log impressions when responding.”

Translated, 6,210 EMS transports related to alcohol in 2016 is an average of 17 trips a day.

DiversionUntil recently, under state law, police departments and rescue personnel were required to take those suspected of being drunk to emergency rooms at hospitals for treatment. In many cases, the emergency room did not offer any specific treatment other than an opportunity for the person to dry out in a safe environment and then be discharged.

A new program begun recently by The Providence Center, called the Recovery Navigation Program, seeks “to provide intoxicated people a safe and supportive place to stabilize,” according to the agency website. The facility is located at the Emmanuel House homeless shelter in South Providence.

The small-scale program works directly with EMS and hospitals for referrals.

ConvergenceRI reached out to The Providence Center for details about the new initiative, asking if patient numbers could be shared.

“Unfortunately, I don’t have any patient numbers for you,” said Jake Bissaro, communications spokesman for The Providence Center. “The Recovery Navigation Program is still in its beginning stages, and we’d like to hold off on reporting any metrics for a few more months,” adding that the city of Providence does not make their ED numbers public.

Bissaro also responded to the question ConvergenceRI asked about whether or not the new standards applied to alcoholism. “I’ve asked around a little bit, and I don’t believe that the new ER rules apply to alcohol intoxication,” he said.

Bissaro added: “At this time, Recovery Navigation is only taking people from the Providence area via EMS, walk in, other provider referrals, and shelters.”

The hospital’s perspectiveConvergenceRI also reached out to Rhode Island Hospital to ask about how the new standards for emergency departments were being applied to intoxicated individuals delivered by rescue personnel to the emergency room, speaking with David Levesque, a senior communications spokesman with Lifespan.

Levesque said he reached out to his ED director but had not heard back by Friday afternoon, March 17, according to a voice mail message left with ConvergenceRI.

[Identifying which hospital that the intoxicated man had been transported to took a bit of legwork. In its story, The Barrington Times had not identified the hospital, and when asked, the editor told ConvergenceRI he did not know.

Lifespan’s Levesque told ConvergenceRI he could not provide any confirmation without a name.

When ConvergenceRI spoke to Barrington Police Chief John M. LaCross, he confirmed that the intoxicated man had been transported to Rhode Island Hospital.]

Can you read the signs?The Rhode Island Department of Transportation has recently undertaken a series of what it described as blunt messaging around drunk driving, posted on some 25 digital billboards across the state, including one message recently, which said: “You drink, you drive = handcuffs!”

In 2015, 19 people died in alcohol-related car or motorcycle crashes, according to RIDOT statistics. In 2014, 17 people died in such accidents, and in 2013, 23 people died, according to agency figures, as reported by The Providence Business News and The Providence Journal.

At first glance, the RIDOT warning signs, focused on drinking and driving, may appear to be somewhat of an effective educational effort.

In the case of the 35-year-old man who died after being seen for detox and then reportedly released two hours later, he was using an Uber driver for transportation [bringing with him an unopened 12-pack of beer]. And, the Uber driver apparently did the right thing, calling the police when the passenger had passed out in the car.

But changes in behavior around drinking and driving do not address the underlying root problem of the continued use and abuse of alcohol by Rhode Islanders.

The apparent omission of alcoholism from the new standards for emergency departments in responding to patients with potential substance use disorders reveals what appears to be a blind spot in the state’s strategic efforts.

What is missing, according to Dr. Michael Fine, the former director of the R.I. Department of Health, is the lack of recognition around the magnitude of use.

“We are in deep denial,” Fine told ConvergenceRI as part of a recent wide-ranging interview. “We are not willing to own our use. We don’t want to talk about the dirty little secret,” reeling off the statistics around Rhode Island’s national leadership in the use of drugs and alcohol. “Too many Rhode Islanders are using one thing or another.”

Rhode Island is not going to treat its way out of the current crisis, Fine continued. “It’s not just about death, it’s about use.”

Recent researchOnce again, the research findings by Shannon Monnat resonate: her study in the 2017 winter edition of Carsey Research found that drugs, alcohol and suicide were the cause of over half the deaths of young white adults, ages 25-34, in 12 states, from 2010-2014, with Rhode Island having had the highest rate, at 59.8 percent. [See link to ConvergenceRI story below.]

In her research, Monnat has sought to connect the high rate of death from drugs, alcohol and suicide to economic stress, to what she has labeled the diseases of despair.

In “The Ghost Bosses,” an investigative story by Brian Alexander in The Atlantic, describes the consequences of private equity firms buying and selling companies and the resulting economic devastation. [See link to story below.]

In his story, Alexander cites Monnat’s work to connect economic instability with the diseases of despair.

“Stability has been replaced by chaos,” Shannon Monnat, a sociologist and demographer at Penn State University who researches the interplay between economics and health, says of such situations. The longer the stress lasts, whether it involves family, community, or work, the more disheartened people become and the more faith they lose in the system, until, finally, they disconnect to survive.

Monnat has recently been studying “diseases of despair” – the plague of opioid addiction, alcoholism, and suicide afflicting places like Lancaster. She’s found that instability at work is strongly correlated with the prevalence of these problems as well as with social and family breakdown. Drug abuse is not solely due to the cheap availability of heroin or meth, nor some imagined weakness of the working class. Monnat believes it’s also caused by people’s loss of faith that they each occupy an important place in the American system.

Editor’s Note: The headline for this story references a song by Frank Zappa and the Mothers of Invention, “America Drinks and Goes Home.”